Healthcare Provider Details

I. General information

NPI: 1245877224
Provider Name (Legal Business Name): WINDELL LAMONT JOHNSON SR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 DOLLARWAY RD STE 301
WHITE HALL AR
71602-3084
US

IV. Provider business mailing address

7604 TOLTEC DR
NORTH LITTLE ROCK AR
72116-4586
US

V. Phone/Fax

Practice location:
  • Phone: 512-201-6766
  • Fax:
Mailing address:
  • Phone: 512-201-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number124247
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number124247
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: